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Endometritis is a uterine disease of dairy cows causing substantial negative effects on reproductive performance and inflicting considerable economic losses. It is typically diagnosed by endometrial cytology evaluation and commonly named cytological endometritis (CEM). In most previous studies, cows were defined as CEM positive if the proportion of polymorphonuclear cells (%PMN) in their endometrial cytology was above a pre-set threshold. Thresholds were established based on CEM diagnosis in association with reproductive performance, typically analyzed by a single reproductive parameter and calculated for all cows together. Our objective was to examine whether primiparous and multiparous cows should optimally be diagnosed for CEM by different %PMN thresholds and sampling timings, using a combination of several reproductive performance parameters. Two endometrial cytobrush cytology samples were collected from Holstein-Friesian dairy cows (n = 415; 269 multiparous; 146 primiparous), at 30-40 d in milk (DIM) and 60-70 DIM, and %PMN were evaluated microscopically (blindly; Diff-Quick stain, Medi-Market). The %PMN thresholds were set at ≥1% to ≥10%, ≥15%, and ≥20%, and accordingly, for each of the thresholds, several reproductive performance parameters were compared between CEM-positive versus CEM-negative cows. Upon application of several analytic approaches, our results indicated that optimal CEM diagnosis should be performed by different criteria in primiparous and multiparous cows: in primiparous cows at 30-40 DIM, using a threshold of ≥7%PMN, and in multiparous cows at 60-70 DIM, using a threshold of ≥4%PMN. Such a diagnostic approach provides a comprehensive view of the reproductive prognosis of CEM-positive primiparous and multiparous cows, which is pertinent information for researchers, veterinarians, and farmers.

Background Abnormal uterine bleeding requires the investigation of the endometrium. Histology is typically used but there remains room for the improvement and use of cytology. Methods Women presenting for clinically indicated office endometrial biopsy were prospectively enrolled. Tao endometrial brushing and office endometrial biopsy were performed, and surgical procedure if clinically indicated. Tao brush cytology specimens were blindly reviewed by up to three pathologists, consensus obtained, and scored as: benign, atypical (favor benign), suspicious, positive for malignancy, or non‐diagnostic. Cytology and histology were compared to surgical pathology to determine sensitivity, specificity, positive, and negative predictive values to detect AH (atypical hyperplasia) or EC (endometrial cancer). Results Clinical indications of 197 enrolled patients included postmenopausal bleeding (90, 45.7%), abnormal uterine bleeding (94, 47.7%), and abnormal endometrium on ultrasound without bleeding (13, 6.6%). Of the 197 patients, 185 (93.9%) had cytology score consensus and a total of 196 (99.5%) had consensus regarding cytology positivity. Surgical pathology diagnoses (N = 85) were 13 (15.3%) FIGO grade 1 or 2 EC, 3 (3.5%) AH, and 69 (81.2%) benign endometrium. Sensitivity and specificity to detect EC or AH were 93.7% and 100%, respectively, via endometrial biopsy; 87.5% and 63.8%, respectively, via endometrial cytology when scores of malignancy, suspicious, or atypical were considered positive. Conclusions In a high‐risk population, Tao brush endometrial cytology showed high sensitivity to detect AH and EC comparable to biopsy histology when considering scores of malignancy, suspicious, atypical, and non‐diagnostic. Revisiting the potential value of endometrial cytology in the contemporary era of endometrial diagnostic workup is warranted., Tao brush cytology is a sensitive tool for endometrial cancer evaluation in symptomatic women. There is a high concordance of Tao brush readings amongst blinded pathologists

The objective of this study was to compare the uterine health between fertile, sub-fertile alpacas and tuis using transrectal ultrasonography, endometrial cytology and bacterial isolation. A total 10 tuis (young mature females without breeding with average age of 1.5 years) and 20 adult alpacas of the Suri breed were used. In turn, the adult females were divided into two groups of 10 animals each according to their reproductive history: fertile group (parturition every year) and sub-fertile group (1 to 2 years without pregnancy). In all females, the thickness of the cervix and uterine horns was determined by transrectal ultrasonography. On the other hand, endometrial cytology and bacterial isolation were performed from samples obtained by uterine flushing. A Kruskal-Wallis and a Chi-square tests were used to compare ultrasonography and cytology groups. A greater thickness of the cervix and both uterine horns (p˂0,05) was observed in the fertile alpacas with respect to the sub-fertile and tuis. The percentage of PMN in tuis and sub-fertile alpacas was < 2%, while in fertile alpacas the percentage of PMN were: 6 animals with < 2% PMN, 2 animals with 2-5% PMN and two other alpacas with > 5% PMN. The bacteria isolated were: Bacillus lechiniformis and Escherichia coli in the three groups studied, Staphylococcus saprophyticus and Bacillus cereus in tuis and fertile alpacas, Staphylococcus aureus in tuis and sub-fertile, Bacillus spp. and Micrococcus spp. in fertile and sub-fertile alpacas, Bacillus lactic acid, Staphylococcus epidermidis and Citrobacter spp. in fertile alpacas, Enterococcus spp., Bacillus subtilis and Klebsiella spp. in sub-fertile and Enterobacter spp. in tuis. The low percentage of PMN in endometrial cytology in sub-fertile alpacas would indicate the absence of endometritis at the time of the study. However, the lower thickness of the cervix and uterine horns observed in sub-fertile alpacas suggest that it would be necessary to perform uterine biopsies in order to evaluate if there is any association between the thickness of the uterine wall and the presence of degenerative and/or inflammatory changes observed on histopathological examination.

The aims of this study were to determine the expression of Bcl-2 in endometrial adenocarcinomas in imprint smears as an alternative technique rather than the frozen section and to correlate the results with clinicopathologic parameters of primary untreated endometrial cancer patients. One hundred twenty-six patients with endometrial carcinoma were evaluated with samples freshly resected after a total abdominal hysterectomy during a 29-month period. One hundred two cases were type I and 24 type II endometrial adenocarcinomas. Positive expression of Bcl-2 was observed only in type I and in low grade carcinomas. Immunocytochemical findings from Bcl-2 stain, appeared to be a valuable predictor of endometrial cancer diagnosis and postoperative prognosis in most cases in endometrial cytology with imprint smears. Furthermore, positive expression of Bcl-2 was related to morphologic features of less aggressiveness (pathogenetic type I, low-grade, early advanced stage, deep myometrial involvement

Background Liquid-based cytology (LBC) is now a widely used method for cytologic screening and cancer diagnosis. Since the cells are fixed with alcohol-based fixatives, and the specimens are stored in a liquid condition, LBC specimens are suitable for genetic analyses. Methods Here, we established a small cancer gene panel, including 60 genes and 17 microsatellite markers for next-generation sequencing, and applied to residual LBC specimens obtained by endometrial cancer screening to compare with corresponding formalin-fixed paraffin-embedded (FFPE) tissues. Results A total of 49 FFPE and LBC specimens (n = 24) were analyzed, revealing characteristic mutations for endometrial cancer, including PTEN, CTNNB1, PIK3CA, and PIK3R1 mutations. Eight cases had higher scores for both tumor mutation burden (TMB) and microsatellite instability (MSI), which agree with defective mismatch repair (MMR) protein expression. Paired endometrial LBC, and biopsied and/or resected FFPE tissues from 7 cases, presented almost identical mutations, TMB, and MSI profiles in all cases. Conclusion These findings demonstrate that our ad hoc cancer gene panel enabled the detection of therapeutically actionable gene mutations in endometrial LBC and FFPE specimens. Endometrial cancer LBC specimens offer an alternative and affordable source of molecular testing materials.

New postpartum strategies have been developed in dairy cows to ameliorate uterine health and reproductive performance, especially the first service conception rates. This study aimed to assess the effect of intrauterine therapy with ozone (IUTO) in early postpartum on subclinical endometritis prevalence and reproductive parameters in dairy cows under commercial farm conditions. For this purpose, eighty clinically healthy cows with a body condition score between 3.0 and 3.5, from four dairy farms, were randomly allocated into two groups: ozone therapy group (OG, n = 40), which were subjected to IUTO, and control group (CG, n = 40). Content of uterine polymorphonuclear (PMN) leukocytes and subclinical endometritis (SE) percentage were assessed at 35 days after calving by uterine cytology. A second cytology was performed 72 h after IUTO. Reproductive parameters such as interval calving to first service (IFS), number of services per conception (nSC), interval calving to conception (ICC) and first service conception rate (FSCR) were analysed. The second endometrial cytology demonstrated that IUTO reduced (P

Minimizing the interval between parturition and successful rebreeding of thoroughbred broodmares is important in maintaining annual foal production and broodmare profitability. Routine postpartum uterine lavage may help achieve this by aiding uterine clearance and involution in the early postpartum period and increasing pregnancy rates. This retrospective study investigates the effect of postpartum uterine lavage in 32 thoroughbred mares housed on a single farm in Australia in 2014 and 2015. In the control year (2014), postpartum uterine lavage was not performed. In the treatment year (2015), all mares received a uterine lavage 3 days postpartum. In both years, endometrial swabs were obtained for culture and cytology at the first postpartum estrus (foal heat swab) and the second postpartum estrus (second heat swab), prior to the mare being bred by natural cover at the second postpartum estrus. There was no significant difference in bacterial culture rates from foal heat or second heat swabs between the control and treatment years. Assessment of endometrial cytology of the foal heat swab and second heat swab revealed a significantly higher proportion of polymorphonuclear cells (PMNs) in the control year compared with the treatment year. Positive culture and cytology rates were significantly higher at foal heat than at the second postpartum heat in both years. No association of year, cytology, or culture with pregnancy rates was identified. In conclusion, routine postpartum uterine lavage significantly reduces the presence of endometrial PMNs at first and second postpartum estrus but does not reduce endometrial culture rates or increase pregnancy rates.

The adoption of endometrial cytology as a diagnostic procedure has been hampered in the past by difficulties arising in interpreting the cellular findings due to a number of factors (such as excess blood, cellular overlapping, and the complex physiology of endometrium). Recently, the use of liquid-based cytology (LBC), with its ability to remove blood and mucus and to distribute cells uniformly in a thin layer on the slide, has provided an opportunity to reevaluate the role of endometrial cytology. LBC samples are easier to screen compared to conventional ones, due to a smaller screening area and an excellent quality of cell preparations. LBC by using peculiar cytoarchitectural features is a useful tool in the cellular diagnosis and follow-up of abnormalities, which, however, remains complementary to histopathology and to the emerging molecular diagnostic cytopathology. This review discusses these various entities and takes into consideration the ancillary techniques that may be useful in the diagnostic procedure. Herein, we also summarize the process and rationale by which updates were made to the standardized terminology in 2018 and outline the contents of the new Bethesda-style classification (the Yokohama system) for the endometrial cytology.

Background Carcinosarcoma of the endometrium is a relatively rare but aggressive neoplasm. Endometrial cytological features of this type of tumor have been rarely reported. This study aimed to clarify the usefulness of endometrial cytological examination in the diagnosis of endometrial carcinosarcoma. Methods Patients histopathologically diagnosed with endometrial carcinosarcoma who underwent preoperative endometrial or endocervical cytological examination were enrolled. The endometrial and/or endocervical specimens were conventionally stained with Papanicolaou stain, and the cytological characteristics, including arrangement and shape of the neoplastic cells, and the nuclear and cytoplasmic features were reviewed. Results Twenty patients were enrolled in the study. In the endometrial specimens, carcinomatous component was detected in almost all cases (94.4%), including those suspicious of carcinoma despite a small volume of carcinomatous cells. Sarcomatous component was observed in 6 of 18 cases (33.3%) and was significantly more frequently detected in the heterologous type (5 of 9 cases) compared to the homologous type (1 of 9 cases) (P = 0.046). In the endocervical specimens, carcinomatous component was present in 76.5% of cases, but sarcomatous component was detected in only 17.6% of cases. Conclusion Although endocervical cytology can detect the carcinomatous component in more than 50% of endometrial carcinosarcoma cases, it has lesser capability to detect sarcomatous component. In conclusion, endometrial cytological examination is a more useful and accurate method to detect sarcomatous component of endometrial carcinosarcoma, particularly in the heterologous type, compared to endocervical cytological examination.

Introduction: Direct smearing preparation (conventional preparation [CP]) has been widely used for endometrial cytology in Japan. In CP, sampling and screening errors are problematic. In liquid-based cytology preparation (LBC), the problems of CP can be solved. But there is a problem that cytological findings of LBC are different from those of CP. The purpose of this study was to evaluate the differences of morphological findings of endometrial cytology between LBC and CP, and the usefulness of the endometrial LBC to differentiate endometrioid carcinoma grade 1 (G1) from grade 3 (G3). Methods: Thirteen cases of endometrioid carcinoma G1, and 5 cases of G3 collected by the Softcyte device and prepared by LBC and CP (split specimen) were used. We focused on the following items: (1) the number of clusters per cm2, (2) the number of layers of clusters, (3) area of clusters, (4) perimeter of clusters, (5) roundness of clusters, (6) complexity of clusters, (7) area of nucleus, (8) perimeter of nucleus, (9) roundness of nucleus, (10) complexity of nucleus, (11) area of nucleolus, and (12) nucleolus-nucleus ratio (N/N). Results: Compared with CP, the number of clusters and layers of the clusters in LBC were significantly larger in G1. The area and perimeters of the clusters and the nucleus were significant smaller, and the N/N ratio was greater in LBC than that in CP in both G1 and G3. Regarding morphological differences between G1 and G3 in LBC and CP, the number of layers was significantly larger in G1 than in G3 in LBC and CP. The area of the clusters in LBC was significantly larger in G1 than in G3. The area and perimeters of the nucleus in CP and the area of the nucleolus and N/N ratio in LBC and CP were significantly smaller in G1 than in G3. Conclusion: In the endometrial cytology, it became clear that the cell image was different between LBC and CP and between G1 and G3. By microscopic examination understanding the characteristics of the cell image in LBC, endometrial LBC could be useful to diagnose endometrial carcinoma.

Objective In this study, we aimed to retrospectively investigate and confirm whether atypical nuclear findings in endometrial cytology are useful when assessed by image morphometry in liquid-based cytology (LBC) and compared with microscopic evaluation. Methods In total, 53 cases were selected for this study, including 11 presenting proliferative endometrium, 12 with surface papillary syncytial change with endometrial glandular and stromal breakdown (EGBD-SPSC), 10 endometrioid carcinoma grade 1 (G1-EEC), 10 EEC grade 3 (G3-EEC), and 10 endometrial serous carcinomas (ESC). Nuclear image morphometry for nuclear geometric features (area, grey value, aspect ratio, internuclear distance, nucleolar diameter) was performed using ImageJ computer software. For assessing nucleoli, 3861 nuclei were measured, and for nuclear findings, except for nucleoli, 4036 nuclei were measured in total. Results (a) Compared with G1-EEC, G3-EEC and ESC presented a marked increase in all six parameters (nuclear enlargement, anisonucleosis, nuclear shade, nuclear shape, irregularity of nuclear arrangement, and nucleolar size). (b) EGBD-SPSC presented a marked increase in two parameters (nuclear shade, nuclear shape) when compared with G1/G3-EEC and ESC. (c) Compared with EGBD-SPSC, EEC and ESC demonstrated a marked increase in nucleolar size (≥2.0 μm). (d) ESC presented a marked increase in nucleolar size (≥3.0 μm) when compared with G3-EEC. Conclusions Here we confirmed that atypical nuclear findings evaluated by image morphometry are as useful as microscopic evaluations in endometrial cytology. We believe that the objective evaluation of nucleolar size could contribute to an accurate diagnosis of endometrial-LBC samples.

Background Endometrial cancer is the second-most prevalent cancer after breast cancer. Endometrial cytology test is a new diagnosis method for endometrial lesions. However, some unresolved issues limited the application of endometrial cytology test (ECT) in early diagnosis and screening of endometrial cancer. Evidence suggests that FRα is overexpressed in various solid tumors such as endometrial cancer, breast carcinoma, ovarian cancer and so on. Based on the expression of FR-α, the agent used in intraoperative imaging, FRα-targeting antibody drugs and diagnosis were developed previously. Nevertheless, research regarding agents used in the diagnosis of endometrial cancer is rarely carried out yet. Methods To obtain a promising and efficient method for in vitro and screening diagnosis of endometrial cytology, we performed the synthesis and evaluation of the new near-infrared targeting fluorescent dye folic acid-ZW800-1 (ZW-FA) and to explore its potential feasibility for in vitro diagnosis of endometrial cancer. Characterisation and Folate receptor-α (FR-α) targeting verification of ZW-FA were performed first and 92 patients were recruited, after liquid-based cytology preparations, during a 15-month period. ZW-FA and Hematoxylin-Eosin (H&E) staining were performed on all cytological slides successively; the histological diagnoses were regarded as the gold standard for ROC curve analysis. Results The cut-off value of ZW-FA fluorescence intensity is 62.9745; the sensitivity (Se), specificity (Sp), false-negative rate (FNR), false-positive rate (FPR), positive predictive value (PV+) percentage and negative predictive value (PV–) of the ZW-FA method are 84.6%, 85.2%, 15.4%,14.8%, 93.2% and 69.7%, respectively. Conclusions ZW-FA is potentially efficient for in vitro diagnosis of endometrial lesions based on the FR-α expression level of different endometrial lesions. This research offers a promising and efficient method for in vitro and screening diagnosis of endometrial cytology. Trial registration: ChiCTR1800020123. Registered December 15, 2018.

Although liquid-based cytology (LBC) has increased the sensitivity of cytological diagnosis of endometrial cancer (EC) compared with conventional smear cytology, the sensitivity of LBC for the detection of EC is between 70% and 96% and remains unsatisfactory. In the present study, we compared the efficacy of LBC with liquid-based genetic diagnosis (LBGDx) by amplicon sequencing of five genes including PTEN, PIK3CA, CTNNB1, KRAS, and TP53 in 48 LBC subjects who underwent endometrial screening. Consequently, LBC classified 15 samples as "positive or suspicious for malignancy" and the 15 were later confirmed as EC. However, LBC failed to identify five cases who were diagnosed as EC by additional transvaginal ultrasound and endometrial curettage, indicating that the sensitivity of cytology alone was 75% (15/20). LBGDx identified 11 pathogenic PTEN variants in 10 subjects, six PIK3CA variants in nine, three CTNNB1 variants in five, two KRAS variants in four, and three TP53 variants in three. Collectively, at least one pathogenic variant was identified in 19 subjects, which included 17 EC (15 endometrioid carcinoma and 2 endometrial carcinosarcomas), and one cervical adenocarcinoma. However, LBGDx did not identify any pathogenic mutations in three of the 20 EC, indicating that the sensitivity of LBGDx alone was 85% (17/20). Although five EC were negative for malignancy by LBC and three were negative for pathogenic mutations by LBGDx, the combination of LBC and LBGDx would successfully diagnose all 20 EC. These data suggested that LBGDx is a useful strategy to improve the sensitivity of screening of EC by LBC.

OBJECTIVE We aimed to develop and reinforce a clinical management regimen for atypical endometrial cell (ATEC) categories within the descriptive reporting format for endometrial cytology. METHODS Between January 2013 and December 2014, 215 samples, for which histological examination was performed immediately or within 3 months after cytology, were cytologically diagnosed as ATEC. For these samples, the medical records were retrospectively reviewed to identify risk factors for malignancy. RESULTS Among 152 samples diagnosed as ATEC, of undetermined significance, 19 (12.5%) were malignant. In the younger group (age

Background To evaluate reproducibility of a reporting system for endometrial cytology. Methods Cytologic slides from 49 patients, prepared via liquid based cytology, were blindly examined by five cytopathologists of various experience levels, applying a recently introduced reporting system as previously reported. The agreement among cytopathologists was evaluated via Kappa (κ) statistics and the Kendall's Coefficient of Variation (W); cytologic results were compared with the relevant histologic report. Results Substantial agreement among all five raters was found in the benign, ACE-L and malignant categories, fair agreement in inadequate and ACE-H categories, whereas only slight agreement in ACE-U. For the three more experienced cytopathologists, an almost perfect agreement was found in inadequate, benign, and ACE-L categories, substantial agreement in ACE-H and malignant categories and fair agreement in ACE-U category. Overall agreement for all five cytopathologists and for all categories was moderate, whereas it was very high for the three senior raters. Using the Kendall's test, both five cytopathologists (W = 0.81) and the three senior ones (W = 0.93) had very high agreement. Sensitivity: 83.33–92.59%, specificity: 83.33–94.74%, ROC area: 71.72–90.3%. Conclusion Application of appropriate statistical tests shows that integration of a new reporting cytologic system is effective with an overall accuracy around 90%. Both statistical tests applied disclosed lower agreement rates among both all five raters and the three most experienced ones in the intermediate categories constituting the gray zone, thus delineating the need for better training of cytopathologists to correctly identify diagnostic criteria for classification of a given case into these categories.

The aim of this study was to investigate the diagnostic accuracy of liquid-based endometrial cytology, in comparison with histology.1987 patients scheduled for hysteroscopy were enrolled in this study. All patients proceeded sequentially through endometrial cytology, hysteroscopy and then dilatation and curettage (DC). Cytology sampling was performed by brushing the uterus cavity using SAP-1 and the sample was prepared to liquid-based smear using SurePath technology. The slides were stained by Papanicolaou method. All cytological diagnosis was correlated with the DC histological diagnosis.Cyto-histological correlations were possible in 1672 (89.3%) patients: in 254 (12.8%) patients the DC was inadequate, in 75 (3.8%) patients the cytology was inadequate, and in 14 (0.7%) patients both were inadequate. In postmenopausal women, 758 of 790 cytologies (96.0%) were adequate, while 586 of 790 histologies (74.2%) were adequate. SAP-1 provided more sufficient materials for cytology than DC for histology (P 0.001). Taking atypical hyperplasia or worse as a positive result, the diagnostic accuracy of liquid-based endometrial cytology was 86.1%, sensitivity was estimated at 70.3%, specificity at 88.5%, positive predictive value at 48.0% and negative predictive value at 95.2%. Taking endometrial carcinoma as a positive result, the diagnostic accuracy of liquid-based endometrial cytology was 94.4%; sensitivity was estimated at 53.2%, specificity at 98.6%, positive predictive value at 79.8% and negative predictive value at 95.3%.Liquid-based endometrial cytology can be considered a useful method for detecting of endometrial pathology as a first-line approach.

In this study, we aimed to determine risk factors associated with cytological endometritis (CYTO) diagnosed at artificial insemination (AI) in dairy cows. The CYTO risk factors were evaluated based on 1.625 AI-CYTO samples obtained from 873 Holstein-Friesian cows from in total 18 dairy herds in Flanders (Belgium). The endometrial cytology samples were obtained using the cytotape technique, which consisted of adapting a 1.5 cm piece of paper tape to a standardly loaded AI catheter, covered with a double guard sheet. The polymorphonuclear cells' (PMNs) cut-off point for CYTO at AI was set at >= 1%. We constructed multilevel generalized mixed effect models in order to identify the risk factors associated with the presence of CYTO at AI. The CYTO prevalence at AI was 27.8% at the animal level, while the within-herd level prevalence ranged from 10.7 to 39.7%, with an average of 28.1%. Risk factors associated with the occurrence of CYTO were parity >= 2 [odds ratio (OR) = 1.8], days in milk (DIM) at AI >= 124 (OR = 0.4), and warm months of the year [July (OR = 2.9), August (OR = 2.3), and September (OR = 1.4)]. In conclusion, the present study supports that multiparous cows and cows that are inseminated in the summer months have a higher risk to suffer from CYTO at insemination, while the risk for CYTO is lower when the insemination is taking place at >= 124 DIM. (C) 2017 Elsevier Inc. All rights reserved.

Small-cell neuroendocrine carcinoma (NEC) of the endometrium is extremely rare, and demonstrates an aggressive clinical course. Since reports describing its cytological features are scarce, we aimed to retrospectively analyze these features. Patients with a histopathological diagnosis of NEC who underwent preoperative cytological examination, were enrolled in this study. The cytological features including the background, arrangement, and shape of the neoplastic cells, and the nuclear and cytoplasmic features were reviewed; six patients were enrolled. The conventionally stained, directly sampled cytological specimens showed small neoplastic cell clusters in all cases, as well as isolated neoplastic cells and large clusters in 3 and 2 cases, respectively, in inflammatory or necrotic backgrounds. These neoplastic cells had a high nuclear/cytoplasmic ratio, and round to oval nuclei with powdery chromatin, inconspicuous nucleoli, and scant cytoplasm. Nuclear molding was a characteristic finding. An adenocarcinoma component was also present in 3 cases. Initial cytodiagnosis revealed small-cell NEC and adenocarcinoma or suspected adenocarcinoma in 1 and 4 cases, respectively. The one remaining case was found to be negative and was considered as degenerated endometrial stromal cells. Primarily owing to overlooking this component, the initial cytodiagnostic accuracy of small-cell NEC was low, particularly in cases with coexisting adenocarcinoma. However, the cytological features of this tumor were characteristic. Therefore, although extremely rare, careful observation is essential for an early and accurate diagnosis and to prevent overlooking the small-cell NEC component.

Endometritis is the most common cause of subfertility and infertility in mares that leads to great economical loss. Endometrial cytology (EC) is a reliable diagnostic tool, widely used to assess the health of the reproductive tract in both humans and domestic mammals. The aim of this study was to compare two techniques for the collection of EC samples in chronically infertile mares. Ten mares aged 4 to 20 were used. In each mare, samples for EC were collected first by cytology brush (CB) and then by low volume lavage (LVL) and stained using the Diff Quick stain. Each sample was assessed for the following parameters: background of the slides, quality and quantity of the cells obtained, number of inflammatory cells. Also, we assessed the number of operators, time and costs needed for each technique. More debris was noticed in the LVL samples, as well as a higher percentage of distorted cells. However, inflammatory cells were detected in all positive samples. Sampling by LVL required two to three operators and recovery of the lavage fluid was sometimes difficult. In conclusion, both techniques are accurate for the detection of uterine inflammation.

Objective: The aim of this study was to investigate the diagnostic accuracy of liquid-based endometrial cytology in postmenopausal women, in comparison with histology. Materials and methods: There were 790 postmenopausal women scheduled for hysteroscopy enrolled in this study. After providing informed consent, all patients proceeded sequentially through endometrial cytology, hysteroscopy, and then dilatation and curettage (D&C). Cytology sampling was performed by brushing the uterus cavity using SAP-1 and the sample was prepared to liquid-based smear using SurePath technology. The slides were stained by Papanicolaou method. All cytological diagnoses were correlated with the D&C histological diagnoses. Results: Cytohistological correlations were possible in 567 (71.8%) patients: the D&C was inadequate in 204 (25.8%) patients; the cytology was inadequate in 32 (4.1%) patients; and both were inadequate in 13 (1.6%) patients. SAP-1 provided more sufficient material for cytology than D&C can for histology (p

Objective Endometrial cytology has been widely used as a screening tool in Japan. Traditionally, a three-tier reporting system, consisting of ‘negative’, ‘suspicious’ and ‘positive’ categories, has been used. However, a more descriptive system, the New Terminology in Endometrial Cytology (NTEMC), which is based on the Bethesda System for uterine cervical cytology, was introduced recently. The objective of this study was to validate the NTEMC criteria. Methods Endometrial cytology specimens that had been categorised as ‘suspicious’ were collected in our hospital between 2003 and 2013, and from these, 106 specimens with corresponding histological results, were re-evaluated according to the NTEMC criteria. Diagnostic categories were assigned based on that chosen by the majority of the examining members. Results Negative, atypical endometrial cells, of undetermined significance (ATEC-US), atypical endometrial cells for which atypical endometrial hyperplasia or worse cannot be excluded (ATEC-A), endometrial hyperplasia, atypical endometrial hyperplasia and malignancy were selected as the diagnostic categories for 9 (8.5%), 34 (32.1%), 17 (16%), 34 (32.1%), 5 (4.7%) and 7 (6.6%) specimens, respectively. Corresponding histological categories of benign, endometrial hyperplasia, atypical endometrial hyperplasia and malignancy were established in 28 (82.4%), 1 (2.9%), 2 (5.9%) and 3 (8.8%) ATEC-US specimens, respectively, and in 6 (35.3%), 3 (17.6%), 2 (11.8%) and 6 (35.3%) ATEC-A specimens, respectively. The histological category distribution differed significantly (P = 0.001), and there was a significant correlation between corresponding cytological and histological categories (P = 0.005). Conclusion The ATEC category of NTEMC system works well in a practical setting and resembles the Bethesda reporting system ASC (atypical squamous cells) category for cervical cytology.

The aim of the present study was to compare endometrial cytology with histopathology to diagnose subclinical endometritis (SCE) in dairy cows. Endometrial cytology samples were collected from Holstein-Friesian cows (n = 32) just before slaughtering. Half of them were obtained by in vivo cytobrush (IV-CB), whereas the other half by in vivo low-volume lavage (IV-LVL). After slaughtering, reproductive tracts were collected, and the endometrium was sampled at eight locations. At each location, both a ex vivo cytobrush sample (EV-CB) and a tissue sample for histopathologic examination were taken. In the histopathology slides, polymorphonuclear (PMN) cell counts were differentiated as PMN cells in direct contact with the epithelial cells of the endometrium (PMN-EP), and PMN cells present in the deeper stratum compactum (PMN-SC). Summation of both countings was referred to as PMN-total. Pearson's correlation and Cohen's kappa coefficient were used to assess the correlation and agreement between both sampling methods (in vivo cytology [IV-CB and IV-LVL] with EV-CB and PMN-total). A Poisson mixed effect model was used to analyze the PMN cells' distribution. The prevalence of SCE was 18.75% (n = 6/32) for in vivo cytology. The SCE prevalence based on EV-CB analyses and on the assessment of PMN-total was determined both at the sample (n = 256) as well as at the cow level (n = 32): EV-CB 25% (n = 64/256) and 35.5% (n = 12/32), and PMN-total 37.11% (n = 95/256) and 59.38% (n = 19/32). Correlation and agreement between IV-CB and EV-CB were r = 0.81 and k = 0.97, whereas between IV-CB and PMN-total r = 0.15 and k = 0.23, respectively. In vivo low-volume lavage correlation and agreement were r = 0.52 and k = 0.66 with EV-CB, and r = 0.45 and k = 0.44 with PMN-total. Moreover, correlation and agreement between EV-CB and PMN-total were r = 0.60 and k = 0.50, respectively. More PMN cells (P < 0.05) were detected in PMN-SC when compared to PMN-EP and EV-CB. A higher SCE prevalence was found using histopathology, rendering the latter as a more sensitive method to diagnose SCE in comparison to in vivo and ex vivo cytology. Although cytology had low and/or moderate sensitivity to diagnose SCE when compared with histopathology, its specificity is 100%, implying that all cows that were indicated to suffer from SCE using in vivo cytology were confirmed to do so by histopathologic examination. There is an uneven distribution of PMN cells throughout the endometrium, generally more PMN cells being found in the deeper stratum compactum than in contact with the superficial layers of the endometrium. (C) 2016 Elsevier Inc. All rights reserved.

BACKGROUND There have been various attempts to assess endometrial lesions on cytological material obtained via direct endometrial sampling. The majority of efforts focus on the description of cytological criteria that lead to classification systems resembling histological reporting formats. These systems have low reproducibility, especially in cases of atypical hyperplasia and well differentiated carcinomas. Moreover, they are not linked to the implied risk of malignancy. METHODS The material was collected from women examined at the outpatient department of four participating hospitals. We analyzed 866 consecutive, histologically confirmed cases. The sample collection was performed using the EndoGyn device, and processed via Liquid Based Cytology, namely ThinPrep technique. The diagnostic categories and criteria were established by two cytopathologists experienced in endometrial cytology; performance of the proposed reporting format was assessed on the basis of histological outcome; moreover, the implied risk of malignancy was calculated. RESULTS The proposed six diagnostic categories are as follows: (i) nondiagnostic or unsatisfactory; (ii) without evidence of hyperplasia or malignancy; (iii) atypical cells of endometrium of undetermined significance; (iv) atypical cells of endometrium of low probability for malignancy; (v) atypical cells of endometrium of high probability for malignancy; and (vi) malignant. The risk of malignancy was 1.42% ± 0.98%, 44.44% ± 32.46% (nine cases), 4.30% ± 4.12%, 89.80% ± 8.47%, and 97.81% ± 2.45%, respectively. CONCLUSION We propose a clinically oriented classification scheme consisting of diagnostic categories with well determined criteria. Each diagnostic category is linked with an implied risk of malignancy; thus, clinicians may decide on patient management and eventually reduce unnecessary interventional diagnostic procedures. Diagn. Cytopathol. 2016;44:888-901. © 2016 Wiley Periodicals, Inc.

Endometritis is the most common cause of infertility in mares; however, many mares fail to be diagnosed despite availability of many diagnostic tests. Our objective was to compare different diagnostic methods and establish a cutoff value for the number of polymorphonuclear cells in cytology samples. Fifty-four mares were classified positive for endometritis based on endometrial biopsy (“gold standard”), and in a later analysis, the mare was reclassified as positive for endometritis if two or more of the following five criteria on a checklist were present (“new gold standard” [NGS]): (1) abnormal clinical findings, (2) abnormal gross character of low-volume lavage (LVL) fluid, (3) positive endometrial cytology, (4) bacterial growth on culture of the LVL pellet, and (5) histologic evidence of inflammation on endometrial biopsy. Kappa (κ) coefficient and percentages were calculated for sensitivity and positive predictive value (PPV) using SAS 9.3 software. Endometritis was diagnosed in 35/44 (79.5%) mares by biopsy. Based on the endometritis checklist, 33/51 (64.7%) mares were positive for endometritis. The character of LVL was 45% sensitive, whereas culture was 22% sensitive, when compared with endometrial biopsy. One percent of neutrophil-to-epithelial cell ratio was the most sensitive cutoff value (93.3%) when using a guarded swab (κ = 0.64). Endometrial biopsy was the most sensitive diagnostic method when compared against the NGS (sensitivity = 86%). Abnormal clinical findings and positive cytology showed moderate agreement with the NGS (κ = 0.41 and κ = 0.38, respectively). These studies demonstrate the importance of combining clinical findings and laboratory data when evaluating mares for endometritis.

The objectives of this study were to investigate the relationship between uterine fluid and endometrial cytology (EC) followed by study of association with uterine involution, calving to first ovulation interval, and conception in dairy cows. On day 43 post-partum, 23 dairy cows were grouped, on the basis of EC, as having low (10%) polymorphonuclear cells (PMN), and the quantity of uterine fluid was assessed by ultrasound. Uterine involution was significantly earlier in cows having low PMNs as compared to high PMNs (24.1 vs. 31.7 d). The interval from calving to first ovulation was significantly shorter in low as compared to high PMN cows (23.4 vs. 30.7 d). With the increase in the quantity of uterine fluid, PMNs also increased from 6% to 21%. The mean interval from calving to ovulation was longer in primiparous cows with high PMN (33 d) compared to that of primiparous and multiparous cows with low PMN (24 and 22 d, respectively). Cows that had uterine fluid on day 43 post-partum had fewer days open than those with no uterine fluid (107 vs. 130 d). So, the conclusion may be drawn that transrectal ultrasonography and endometrial cytology, when combined together, on day 43 post-partum, have diagnostic value in the assessment of uterine inflammation., Cilj ovoga rada bio je istražiti odnos između maternične tekućine i citologije endometrija (EC) te povezanost s involucijom maternice, vremenom od teljenja do prve ovulacije i koncepcijom u mliječnih krava. Četrdeset i tri dana poslije teljenja 23 mliječne krave svrstane su u skupine s obzirom na to imaju li mali broj (manje od 10 %) ili veliki broj (više od 10 %) polimorfonuklearnih stanica (PMN), dok je količina maternične tekućine procijenjena ultrazvukom. Do involucije maternice došlo je znakovito ranije u krava s malim broj PMN-a u usporedbi s onima s velikim brojem PMN-a (24,1 prema 31,7 dana). Vrijeme od teljenja do prve ovulacije bilo je znakovito kraće u krava s malim brojem PMN-a u usporedbi s onima s velikim brojem PMN-a (23,4 prema 30,7 dana). S porastom količine maternične tekućine porastao je i PMN, sa 6 % na 21 %. Prosječno vrijeme od teljenja do ovulacije bilo je dulje u prvotelki s velikim brojem PMN-a (33 dana) u usporedbi s prvotelkama (24 dana) i starijim grlima (22 dana) s malim brojem PMN-a. Krave koje su imale materničnu tekućinu 43. dan poslije teljenja imale su nekoliko dana kraći puerperij od onih bez maternične tekućine (107 prema 130 dana). Možemo zaključiti da transrektalni ultrazvuk zajedno s citologijom endometrija 43. dan poslije teljenja ima dijagnostičku vrijednost u procjeni upale maternice.

Introduction This study evaluated the immunocytochemical (ICC) expression of IMP3 in direct endometrial brushings processed as liquid-based cytology (LBC) samples of endometrioid adenocarcinoma (EAC), serous carcinoma (ESC) and surface papillary syncytial change (SPSC) with endometrial glandular and stromal breakdown (EGBD) to exploit its possible differential diagnostic aid. Methods In total, 333 samples of LBC samples were obtained from selected outpatients in parallel with Pipelle endometrial sampling. They consisted of 97 EAC (83 grade 1: EAC-1, 14 EAC-3), 35 ESC and 201 benign endometrial samples (51 proliferative, 42 secretory, 38 atrophic, 70 SPSC with EGBD). ICC expression of insulin-like growth factor-II mRNA-binding protein 3 (IMP3) was manually performed on Papanicolaou-stained LBC samples. Results The ESC samples showed positive staining cells in 100%, EAC-3 in 28.5%, and EAC-1 in 2.4% cases. All the benign endometrium samples were negative. Only ESC cases showed strong immunoreactivity (≥3+) in more than 50% of tumour cells with an average frequency of 80%. Conclusions IMP3 is a helpful immunomarker to distinguish ESC from EAC and SPSC in endometrial cytology.

Objective We conducted a prospective, multicentre study to compare the clinical performance of liquid-based endometrial cytology (LBEC) using SurePath™ with that of suction endometrial tissue biopsy (SETB). This study is officially advocated and reported by the Japan Association of Obstetricians and Gynecologists. By publishing our midterm data, we intend to disseminate the benefits of LBEC system, using the descriptive reporting format and algorithmic interpretational approach. Methods From April 2014 to December 2015, we consecutively assessed 1116 LBEC specimens and 1044 SETB specimens in our five outpatient clinics. Results The sensitivity of suction tissue biopsies was 85.2%, whereas the sensitivity of LBEC was 92.2%. The specificity of suction tissue biopsies was 98.9% and that of LBEC was 98.5%. The negative predictive value of LBEC (99.1%) was higher than that of SETB (98.1%), although the difference between these values was not significant. Conclusions The clinical performance of LBEC for detecting endometrial malignancies was almost identical to the performance of SETB. This indicates that LBEC was not inferior to SETB for the detection of endometrial cancer. The LBEC is appropriate for various clinical situations as the first-step detecting tool. In addition, it could be used for cancer surveillance for women with signs highly suggestive of endometrial malignancies and in Lynch syndrome patients, on a larger scale.

Context: Endometrial aspiration is not a popular modality for the study of the endometrium despite its simplicity and potential utility. Aim: The present study was aimed at evaluating the utility of endometrial aspiration in various gynecological disorders. Materials and Methods: In this diagnostic accuracy study, 55 prospectively registered women with various gynecological disorders were evaluated clinically and subjected to endometrial aspiration cytology and study of endometrial histology. Endometrial aspiration was performed by infant feeding tube in 10 cases and intra cath cannula in 45 cases. The slides were stained with rapid Papanicolaou (PAP) stain and Leishman stain. Results: Endometrial aspiration cytology showed 90% and 94.6% sampling adequacy with infant feeding tube and intra cath cannula, respectively. Intra cath cannula was very convenient to handle and superior to infant feeding tube in aspirating the endometrium. Of the two stains used, rapid PAP stain was less time-consuming and superior to Leishman stain in studying the nuclear details. Leishman stain was helpful in detecting cytoplasmic vacuoles of secretory endometrium. Overall diagnostic accuracy of endometrial cytology was 90.4% while that for morphological hormonal evaluation was 97.6%. It enjoyed a sensitivity of 91.66%, a specificity of 88.23%, positive predictive value of 94.28%, and negative predictive value of 83.33%. Conclusion: Intra cath cannula emerged as an inexpensive, effective, and convenient device for endometrial aspiration. Endometrial aspiration proved to be a fairly effective, simple, and informative diagnostic modality.

Summary Endometritis is an important cause of reproductive pathology in the horse. Endometrial cytology preparations from unguarded swabs, guarded swabs or brushes, cap of a guarded swab, low volume lavage or even an endometrial biopsy sample can be utilised to rapidly evaluate uterine health. These cells can easily be stained with a modified Wright's stain and evaluated for the presence or absence of inflammatory cells and pathogens. Commonly visualised cell types are easily identified with a traditional light microscope at 400× or 1000× magnification. This technique provides an easy and rapid way to diagnose endometritis in the horse.

The aim of this study was to evaluate the diagnostic efficacy and utility of liquid-based cytology in ThinPrep (Cytyc Corporation, Boxborough, MA) for endometrial lesions in patients presenting with abnormal uterine bleeding. Two hundred and thirteen women scheduled for dilatation and curettage because of abnormal uterine bleeding were enrolled in the study. After providing informed consent, all the women proceeded sequentially to endometrial cytology and then dilatation and curettage. In the premenopausal group, cytological failure was 4.8%, histopathological failure was 2.4%; cytologic insufficiency in the postmenopausal group was 2.1%, and histopathologic insufficiency was 19.6%. When cytologic and histopathological sufficiency rates were compared in all cases, cytologic insufficiency was 4.2% and histopathologic insufficiency was 6.1%. This difference was statistically significant (p

En el presente estudio se determinó la prevalencia de endometritis subclínica y su efecto en la tasa de gestación en vacas lecheras en manejo intensivo. Entre los días 35 y 45 posparto se seleccionaron 237 vacas sin patologías uterinas (vacas con útero involucionado y sin secreciones vaginales anormales); a todas ellas se les tomó una muestra citológica de endometrio mediante la técnica de Cytobrush. Los frotis se procesaron con la tinción de Diff-Quick. Se contaron un total de 200 células y se determinó la proporción de células polimorfonucleares (PMN). Las vacas con ≥ 6 % de PMN se consideraron con endometritis subclínica. Cuarenta y tres por ciento (103/237) de las vacas presentó endometritis subclínica. Las vacas con puerperio patológico tuvieron mayor probabilidad de padecer endometritis subclínica que las vacas con puerperio normal (60 vs 36 %, respectivamente; razón de probabilidad= 2.69). Las vacas normales tuvieron mayor tasa de gestación en el primer servicio que la vacas con endometritis subclínica (31.4 vs 20.0 %; respectivamente; razón de probabilidad= 2.02) y la proporción de vacas gestantes en el día 120 posparto fue mayor en las vacas normales que en las vacas con endometritis subclínica (51.6 vs 37.9 %, respectivamente; razón de probabilidad= 1.98). Se concluye que la prevalencia de endometritis subclínica en vacas lecheras entre los días 35 y 45 posparto es de 43 %, lo cual disminuyó en un 11.4 % la tasa de gestación en el primer servicio y en un 13.7 % la tasa de gestación acumulada en el día 120 posparto., The present study determined the prevalence of subclinical endometritis and its effect on pregnancy rate in intensively managed dairy cows. Between d 35 and 45 postpartum, 237 cows with no uterine pathologies judged to have completed uterine involution and no abnormal vaginal secretions were selected. Endometrial cytology samples were taken from each cow using the Cytobrush technique, and smears were stained with Diff-Quick. A total of 200 sample cells were counted and the proportion of polymorphonuclear leukocytes (PMN) was estimated. Cows with ≥6 % PMN were considered to have subclinical endometritis; 43 % (103/237) of cows sampled met this criterion. Cows with pathological puerperium had a higher probability of undergoing subclinical endometritis than cows with normal puerperium (60 vs 36 %, respectively; odds ratio= 2.69). Cows not presenting subclinical endometritis had a higher pregnancy rate at first service than cows with this condition (31.4 vs 20.0 %, respectively; odds ratio= 2.02), and the percentage of pregnant cows at d 120 postpartum was higher in cows not experiencing subclinical endometritis than in cows with this condition (51.6 vs 37.9 %, respectively; odds ratio= 1.98). It concludes that 43 % of cows suffered subclinical endometritis between d 35 and 45 postpartum, which decreased pregnancy rate at first service, as well as cumulative pregnancy rate at d 120 postpartum., Consejo Nacional de Investigaciones Científicas y Técnicas, Facultad de Ciencias Veterinarias

The obstetric assistance of dystocia in field conditions promotes greater bacterial contamination of the uterus, causing subclinical endometritis. The aim of this study was to determine the occurrence of subclinical endometritis in beef heifers receiving professional calving assistance, and to evaluate endometrial cytology as a diagnostic technique compared to uterine biopsy. A group of 829 Angus heifers were assisted at calving. Dystocia was classified based on difficulty at assistance, which was estimated as complex or simple. At the end of the calving season, 93 dystocic heifers were reported (10.7%). The percentage of simple resolution and complex resolution was 88.2% and 11.8%, respectively. After 60 days of calving, all animals underwent a gynecological examination, endometrial cytology, and uterine biopsy. In all, 38.9% of heifers presented subclinical endometritis diagnosed by endometrial cytology (sensitivity = 78.6%, specificity = 95.8%). There was a significant association (r = 0.8528) between uterine cytology and uterine biopsy. No associations were observed between endometrial cytology or biopsy and calf viability, or between endometrial cytology or biopsy and calving resolution. Endometrial cytology is a noninvasive technique with high specificity and repeatability for the diagnosis of subclinical endometritis postpartum in dystocic beef heifers.

Background: Cytology of the endometrium is an underused technique in diagnostic pathology. It has been used in the past for endometrial hyperplasia and carcinoma. Only few studies have used cytology in the diagnosis of dysfunctional uterine bleeding (DUB). Endometrial imprint cytology has been rarely used except for application of immunocytochemistry in diagnosis of endometrial carcinoma. Aim: The present study was conducted to evaluate whether it is possible to assign histopathology-like diagnosis by imprint cytology and also to evaluate its usefulness in the assessment of patients of dysfunctional uterine bleeding of low clinical suspicion. Materials and Methods: Imprint smears were made from 93 curettage materials during a study of DUB. Blinded analysis of imprint smears was performed by using McKenzie's criteria and some criteria devised for the requirements of this study. Results of cytology were correlated with histopathology. Statistical analysis was carried out by GraphpadInStat Demo. Results: Majority of the patterns classifiable in histopathology could also be classified in this study on imprint cytology. The overall sensitivity and specificity of cytology in the detection of endometrial patterns in DUB patients were 91.23% and 83.87%, respectively, although the sensitivities and specificities differ according to the phase of endometrium. Conclusion: Histopathology-like categories can be assigned on imprint smears in the diagnosis of DUB. Endometrial imprint cytology can be helpful in centers where histopathology laboratories are not available and even in well-established institutes. It is possible to improve the sensitivity and specificity with better imprinting techniques.

Objective: Histopathological variation has been demonstrated in grade 3 endometrioid adenocarcinomas. We attempted to evaluate the clinicopathological features of grade 3 tumors by endometrial cytological features using a scoring system. Study Design: Twenty-one endometrial cytological samples were evaluated using 5 cytological features: rates of cluster formation in tumor cells; nuclear pleomorphism; nuclear dimension; size of nucleoli, and chromatin structure and distribution. The relationships between cytological scores and clinicopathological factors or prognosis were investigated. Results: The median cytological score was 6 (range 4-14); therefore, samples with scores of 4-5 were defined as having low scores, while those with scores of 6-14 were defined as high scores. The accuracy of the cytological diagnosis for grade 3 tumors in the high score group (8/10 patients, 80.0%) was significantly higher than that of the low score group (2/11 patients, 18.2%; p = 0.009). Significant relationships between cytological scores and lymph node metastases or positive peritoneal cytology were observed (p = 0.03 and 0.035, respectively). The overall survival rate was significantly worse in the high score group (30.0%) than the low score group (88.9%; p = 0.02). Conclusions: Grade 3 endometrioid adenocarcinomas varied in cytological features; according to the scoring system used, high scores were associated with worse clinicopathological factors and poorer prognosis than low scores.

The aim of the study was to examine cytological changes in the uterus in cows during the follicular and luteal phases of the ovarian cycle, as well as to compare two different methods (brush and flushing) used for cytological material collection and to evaluate their usefulness for monitoring of the endometrium. Ovarian cycle phases were confirmed by ultrasound and by the level of sex hormones (17-β-estradiol and progesterone). The following types of cells were identified in the cytological smears: type I - surface cells; type II - intermediate cells; type III - basal cells; polymorphonuclear leukocytes (PMNs); L - lymphocytes. The number of type I and III cells was statistically significantly higher in the follicular phase than in the luteal phase, both in smears prepared using a brush (P

Background The main purpose of directly sampled endometrial cytology is to detect invasive endometrial malignancies. With this principle in mind, The Yokohama System (TYS) Working Group, composed of cytopathologists, surgical pathologists, and gynecologic oncologists met at the 2016 International Congress of Cytology, Yokohama, with the aim to publish a standardized reporting system inclusive of specific diagnostic categories and cytomorphologic criteria for uniform and reliable diagnosis of endometrial malignancies on directly sampled endometrial samples. Methods The diagnostic cytopathologic criteria previously published in the literature by the Japanese and Greek working group on endometrial cytology (Yanoh et al. [2012] Acta Cytol. 56:233; Margari et al. [2016] Diagn Cytopathol. 44:888-901) were critically reviewed with the aim of correlating the diagnostic classes to well defined risk categories for endometrial carcinoma (EC). Moreover, two classes of "atypical" endometrial cells were correlated respectively to a low- and high risk group. Some methodological suggestions for the application of ancillary special technologies to liquid based samples were also given. Results The TYS group conceived a new Bethesda-style classification for directly sampled endometrial cytology which correlates the cytologic diagnostic classes with definite risk categories. The cytomorphologic findings have been correlated to the molecular pathology of EC, also through the application of ancillary special techniques to liquid-based samples. Conclusions The success of TYS will depend on the acceptance of TYS by all the relevant pathology and gynecologic oncology communities who, by their joint efforts, will adopt, critically evaluate, and optimize this method with the only aim of further improving the impact of endometrial cytology on patients' care.